North Dallas Surgical Specialists, PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

NORTH DALLAS SURGICAL SPECIALISTS, PA

Practice address

3600 Shire Blvd Ste 104
Richardson, TX 75082-2236

Phone

(972) 487-6400

Fax

(972) 487-1686

NPI assigned

Jun 30, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Vacendak

Title

Office Manager

Phone

(972) 487-6400

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Louis Bailey, M.D.

  • Surgery Physician
  • Richardson, TX
  • NPI 1114979796
  Medicare reassignment Care Compare group NPD
• Ronald Dennis Baxter Jr., M.D.

  • Surgery Physician
  • Richardson, TX
  • NPI 1457746547
  Medicare reassignment Care Compare group NPD
• Russ Deacon Birdwell, M.D.

  • Surgery Physician
  • Richardson, TX
  • NPI 1376595991
  Medicare reassignment Care Compare group NPD
• Walter Stuart Johnston, M.D.

  • Surgery Physician
  • Richardson, TX
  • NPI 1558312504
  Medicare reassignment Care Compare group NPD
• Thomas Tien-Yau Wang, MD

  • Surgery Physician
  • Richardson, TX
  • NPI 1629395967
  Medicare reassignment Care Compare group NPD
• Donna Lynn Bailey, P.A.-C.

  • Surgical Physician Assistant
  • Richardson, TX
  • NPI 1659464691
  NPD (past)
• Cynthia Chernyakhovsky, P.A.C.

  • Physician Assistant
  • Garland, TX
  • NPI 1184712499
  NPD (past)
• Gail S Lebovic, MD

  • Plastic and Reconstructive Surgery Physician
  • Dallas, TX
  • NPI 1003975525
  NPD (past)
• Trent Lee Proffitt, M.D.

  • Vascular Surgery Physician
  • Albuquerque, NM
  • NPI 1578513396
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646611200000",
    "number": "1912935560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 SHIRE BLVD STE 104",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822236",
            "telephone_number": "972-487-6400",
            "fax_number": "972-487-1686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 SHIRE BLVD STE 104",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750822236",
            "telephone_number": "972-487-6400",
            "fax_number": "972-487-1686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH DALLAS SURGICAL SPECIALISTS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A",
        "authorized_official_last_name": "VACENDAK",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "972-487-6400"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "080799202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• North Dallas Epilepsy, PLLC
• North Dallas Family Care PA
• North Dallas Imaging Providers, LLC
• North Dallas Physical Therapy Associates PC
• North Dallas Primary Care P.a
• North East Infusion Center
• North Richardson Dentistry Associates, PC
• North Star Dental PLLC
• North Texas 101 Mobility LLC
• North Texas Ambulatory Procedure Center

• Surgery Physician in Richardson, TX
• Providers in Richardson, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.